Should annual caps and lifetime caps be allowed in the case of individual insurance companies providing health care insurance?

Should there be annual caps and lifetime caps on health coverage in the case of single payer health care plans and in the case when a national health care system covers the health care of the individual?﻿

I would have no conceptual difficulty with caps being placed on private insurance policies, so long as that condition is clear, and so long as the market is free, i.e. so long as individuals can purchase some other insurance, if they so choose. If you want to sell an insurance policy that only pays out on Tuesdays, I don't have any problem with that, either, so long as that condition is clear and I'm free to purchase some other insurance, or no insurance at all.

I don't support national, government-mandated health insurance policies, precisely because the choice of a different [or no] policy is removed from the individual, so I cannot answer the second question meaningfully.﻿

+Martijn Vos A lot of people seem to want that, but don't want to say it out loud. Perhaps even to themselves.

+Earl Hollar You're talking about free markets and choices in the abstract. But are you willing to concede that in the concrete, this really does mean euthanasia? People who can't afford insurance will die.

(I'm not being hostile here... It's a perfectly feasible and defensible position, as long as it's clearly stated. I disagree vehemently with it, but it would still be a consistent position).﻿

Health care vs health insurance. I've been thinking about this a lot... what happens when robots begin replacing doctors...

No... not some creepy looking silver mechanoid standing over you with a syringe... although things like the davinci surgical bot do exist and are absolute marvels.

what happens when databases and tools and diagnostic machines become so simple and fail-safe that the local pharmacy gets a blood and saliva sample, and checks it in real time with an app on their computer and gives you a pretty accurate diagnostic?

What happens when you can hold your cell phone up to a strip of treated paper and get some fifty or sixty diagnostic tests run because of the micro channels and reactions in the paper?

When those tricorders from star trek aren't science fiction anymore? you think we aren't close to that? I saw a hand held sonogram that hooks up to a phone the other day.

When DNA sample sizes are so large that a pretty accurate map of which medications would work and which wont is a keystroke away?

Why would health care be so expensive if most of the things doctors do... (not all.... just most)... you can now do yourself? or someone could do with a LOT less training needed, and a 'real" doctor is there for all the "non-routine, service orientated" needs.

We mentioned artificial markets the other day, and deliberately keeping resources limited that don't need to be. I'd say medical care is the biggest culprit of this... Lives are lost due to profit margins every day. and there are very few things I would consider a "sin"

+Earl Hollar The problem is that if insurance companies are free to do this, then a lot of people will not be free to take a different insurance, because no insurance company will have them. Or they'll offer nowhere near enough coverage for their medical needs.

If you take this road, you'll end up with a society where people who are born with a medical condition will not be able to get insurance, and they'll only be able to get health care if they're rich. If something serious happens, you've got to let them die.

The thing about health care is that most people need very little of it, and a few people need a lot, through no fault of their own. If you spread the costs of health care, it's quite affordable and accessible for everybody. If you let people opt out, then it very quickly becomes unaffordable for the people who really need it.

And if anyone thinks: I'm healthy, and I don't care about all the sick people, consider that anyone can get hit by a car and spend much of the rest of his life in hospital.﻿

+Martijn Vos The United States Health Care System, before Obamacare, was exactly as you described.

If you had a preexisting medical condition, you could not get health insurance in the United States before Obamacare. Every insurance company would turn you down. If an insurance company did offer insurance, they would have exorbitant premiums with high deductibles with caps; the insurance they offered, many times, was worth zilch.

You were expected to become impoverished, they call it a spend-down, so you could qualify for Medicaid. Medicaid is for the poor.

Please do a google search: spend down medicaid

There is a stigma attached to being on Medicaid.

Please do a google search: stigma medicaidWith Obamacare, insurance companies can no longer use a preexisting medical condition to deny you insurance.﻿

+Richard Sewill My personal position is that insurance is not a right, therefore private insurers are under no legal responsibility to offer insurance to everyone. If an insurance company only wanted to cover people with one leg, or not cover people with violet eyes, that wouldn't trouble me, either. I believe companies should be free to offer the services they choose, while individuals should have the right to freely choose which companies' services to accept.

+Jakke Mäkelä Let me get the nitpicking out of the way quickly, so I can actually address your excellent point. "Letting someone die," isn't "euthanasia," which is a very specific kind of dying, i.e. the kind where someone intentionally kills you to prevent your suffering.

That aside, yes, I agree my position does mean some people will die. More significantly, it means that some people won't get treated for injuries or illnesses that don't include death: dying sucks, but it's certainly not the worst possibility. But anyway, I agree that, yes, people's illnesses and injuries would go untreated, sometimes leading to death.

Governments are funny things: they exist by consent of the governed, even though we don't actually get to pick how they work until long after we're born, and only then in a limited capacity. But if I got to pick the kind of government I'd prefer to live under, it would be one in which my survival is my responsibility, and not anyone else's. The government's purpose would be to safeguard me from other citizens, as well as citizens from other nations, but it wouldn't be responsible for protecting me from entropy, or bad eating choices, or a drunk driver plowing into my car. The responsibility for those things would be me, me, and the drunk guy, respectively.

Your chosen kind of government is likely more of the north-western European type, where the government is responsible for serving you in a broad variety of ways, and in which the government would be responsible, for example, for treating all your illnesses and injuries, feeding you if you can't get food, housing you if you can't get housing, etc. Having lived for a time in the Netherlands, I think that's a perfectly acceptable position, it's just not the one I'd choose. We value the balance of liberty and safety differently, is all, as you note.﻿

I have recently read a good article about how people in the US often neglect medical conditions until it gets too bad to ignore, and by that time the cost of required treatment has gone through the roof and also healthwise they end up much worse off.

+Martijn Vos If no company will provide a service, then the service simply won't be available. There are many, many lifesaving services companies and governments could offer, and don't, because the costs are too high, or because the populace doesn't support the level of services. One could argue police aren't enough, and each human being has a inalienable human right to a personal body guard: after all, without a personal bodyguard, many people will die through no fault of their own. But I personally prefer to live in a society where companies are free to choose which services they offer, and in which survival is, by and large, an individual responsibility and not a collective one.

Your position is perfectly reasonable, as well! Like I mentioned to the honorable Mr Mäkelä, I lived in Nederland long enough to grasp the power and capability of a more-full-service government, it's simply not my personal preference. We each assign different weights to different values - quality of life, individual liberty, etc - when we make assessments like this, and so I'm certainly not saying your way is wrong, simply that by the weights I assign to these values, a government so overarching would come at an unacceptable cost.

Just so we're all clear here, my money's where my mouth is. I'm eligible for government health insurance, but I do not take advantage of it. If I'm injured or ill and cannot pay the doctor or hospital myself, I simply don't go to the doctor or hospital. [I also don't ask other citizens to give me a car if I can't afford one, or food if I can't afford it.] Certainly that's led to complications in my life, but I would not have others take responsibility for me; my survival is my responsibility, and not theirs.﻿

+Earl Hollar When faced with survival, few of us have the strength to stand on principle and die quietly. Even fewer could watch their child die just to make a point. When an existential threat comes into the picture, we grasp at whatever straws are available. I'm glad you're strong enough. That makes one of us.﻿

Should we privatize Medicare making it a question whether or not an elderly person can get health care by making it a question whether or not an elderly person can afford the Medicare premiums privatization would bring?﻿

+Travis Heppe My life isn't much like other people's. I've been very, very near death many, many times without resorting to making other citizens pay for my conditions, for my choices. I don't think that makes me stronger than other people, only that my life's lessons have been very different. But if you intended a compliment - and I sense you didn't, but we'll set that aside - I gladly accept it.

+Richard Sewill Perhaps unsurprisingly, no, I don't support Medicare or Social Security. :) Again, I prefer individuals take responsibility for themselves [and those they choose to take responsibility for; charity is laudable and delightful]. I've been denied the choice of opting out of those programs, as I may well be about to be denied the choice of opting out of health care coverage. That's not "bad" or "wrong," it's simply, again, not my personal preference.

And that's just from a stance of principle: mathematics tells us pay-as-you-go pension systems like Social Security only work for specific levels of growth; hence Italy, and many of the other European nations with negative growth rates and busted pension systems. That's not an indictment of government pension systems - I don't like them, but many people do! - only an indictment of the specific means most governments currently use to fund them [though up on the battlefield, and not invented by mathematicians!].﻿

+Earl Hollar Thanks for the cogent summary! Even when I disagree, I respect it when people are willing to think their positions through.

Having said that, I disagree vehemently... I think really at the axiomatic level. It is indeed a question of different balancing, but in this case the balancing is so different that I don't think we're on the same continuum. (I'm a left-wing Scandinavian, and somewhat proud of it).

OK, let's compare the capless and capped models. Every system has a potential fatal flaw that makes it vulnerable. In the capless system, the flaw is that in principle there's no limit to how much money will be spent, with smaller and smaller returns. There's no rational reason to treat a 105-year-old cancer patient except to give palliative care, but in the capless system there's no ethical way to deny that care. So it has to be balanced by some hard-nosed economic decisions about what is worth doing.

The capped system: would you agree that it's potential flaw is that it will polarize society so completely that it becomes unstable? I'm thinking concretely here: if I heard that I had cancer that is easily treatable, but untreated will kill me in a year, and heard that I was uninsurable and thus doomed... Well, if I had no family, I guarantee that I would spend most of that year thinking of ways to get even with the lucky 1%. Some people prefer to go gently, I'd want revenge. (It's a cultural thing, our civil war in 1917 was particularly heavy with revenge).

So should there be some mechanism in place to prevent this kind of instability? A strong police force certainly helps (and in a market economy security can always be bought). But would a more compassionate solution be more cost-effective in the long run?﻿

I remember some years ago, when a mountain of insurance companies suddenly declared they were no longer going to do business in California. What happened was there was a citizen initiative on the ballot, calling for a change in rules which apply to how insurance companies were to offer services and prices to the public. Most insurance companies decided they could no longer make a profit under those conditions, so they left the market.﻿

Would letting corporations have their own military remove one of the externalities regarding the price of oil by having the oil companies fund their own military?It is my view the United States tries to be the world's policeman. I wish the United States did not do this.﻿

I absolutely 100 percent agree a capped government-mandated system would be unworkable, for a number of reasons. I'm not sure that it'd result in a public uprising - it depends on the populace of the nation, I suspect: in Uganda it wouldn't mean much; in Sweden there'd be hell to pay - but I think it would absolutely polarize society and produce a variety of possibly unsurvivable instabilities. Definitely no bueno.﻿

I remember cases of kids who fell thru ice, and were under water for like an hour, fished out, the rescuers ignorant how long they had been down there, got them breathing again, they fine now. So the question got asked how come they live, when they were under water so long. Turns out the problem is not how long a brain id deprived of oxygen, but the conditions under which the brain is deprived (temperature plays a huge role), and when the blood returns.The blood vessels, to the brain, are held open by the blood flow, then collapse, blocking future blood flow, unless the first return introduces a chemical which opens the path. That chemical is frightfully expensive, so hospitals don't stock it, don't use it. Sounds like there has been no meaningful research to find an alternative.﻿

+Richard Sewill I was similarly astonished to discover there were people who did think health care was a right! [Turns out there's no objective set of human rights! Who knew? :) ] I suspect my position has a great deal to do with where and when I was raised, at a place and time where and when individuals took care of themselves, and took care of the other people in their community. This works reasonably well in a community of a thousand, and very poorly in a community of a million, which is one of the many reasons you won't see me living in a city any time soon.

Your reductio ad absurdum goes the other way, too: if governments are supposed to take care of everything, why don't we have government-mandated food? Why isn't a car an essential human right? Why don't we all have a division of US Marines behind us all day long?! But that's exactly the thing: it's a scale, and depending on the valuation one places on various characteristics, you're going to support a different position on that scale. Many people do support government-mandated food, transportation, and levels of public safety I personally find painfully draconian; those are valid positions, they're not just going to produce the kind of nation in which I'd like to live, one in which liberty is minimized in exchange for increased services.

For a long while, I was against centralized militaries and police forces, as well; I'm not sure if I was an anarchist or just really libertarian. ;) But my position now is that national defense and public safety - like education and road-building - cannot meaningfully, fairly, and justly be done by the individual [at least in countries the size of the ones we have now] and thus must be done by the state if it's to be done at all. But strong arguments can be made for all sorts of positions along the spectrum, and I'd deny none of them. It's all matter of what sort of nation you want.﻿

Depends on a few factors... If an insurance company can say they don't have to accept you, and a hospital said the same, and then your Doctor unfortunately told you the same... No one else wants to help you. Congrats you have been just handed a death sentence. Is that fair?﻿

Oh I'm very left-leaning indeed... But this is a really good opportunity to pick +Earl Hollar's brain, as it's not common to discuss things sanely with a strong libertarian (that is the correct term I guess?).

Using Uganda as an example is intriguing. Would some of the more anarchic African countries actually be an ideal state for you? No government-mandated coddling there. There's plenty of government corruption of course, but if you can afford to pay, then that is zero problem.

The poverty of those nations makes them unattractive right now, but are they in principle being run in the right way?﻿

She went to the hospital, and was refused treatment, even though she was on medicare. The hospital asked her to leave, but she said she was in too much pain to walk, so the hospital called the police. She also told the police she was in too much pain to walk, so the police dragged her body along the concrete, and placed her in a jail cell, 15 minutes after arriving there, she was dead.﻿

+Jakke Mäkelä As long as we're clear that I'm libertarian, but not really a Libertarian. :) That is to say, while I hold many very similar philosophical views, I'm not a member of the actual party, and anything I say shouldn't be held against them!

That out of the way, yes, I often consider African and Asian third-world nations as possible homes, but the thing is, those aren't really libertarian democracies, they're dunamocracies* in which rule is enforced by the strong, and in which laws are not enshrined in constitutions and upheld by governments: they're far more anarchist than libertarian. I couldn't say if these sorts of nations are being run in the "right" way, because I don't believe there is an objective "right" way, but I can say with some authority that they're not being run in a way that makes me want to live there.

My choice? It might seem counter-intuitive, but as soon as possible - within the next five or ten years, I hope - I plan to move to remote northern Canada. The government is socialist-ish, yes, but they're also very far away. So you basically do what you wish, unless you infringe on someone else's rights, but still get your tiny say in what happens to your nation. Yes, I could just move to Alaska, but the United States has been disappointing me for a decade or two now.

+Alister Macintyre This should by no means prevent you from providing additional cases, but I think everyone here agrees that sometimes people are, justly or unjustly, legally or illegally, denied treatment, even unto death. So we're probably all set on examples.

+Jera Wolfe I know very little of the medical profession, but my skepticism is aroused any time my source is an about.com article including phrases like, "Some patients," "They believe," "there have been reports," and "in some fashion." I'll continue to hold a grain of salt for medical blacklists, in the absence of alternative evidence.﻿

I am sharing several recent stories to explore the allegation that there is denial of medical care, and the probability that this can place the patient's life at dire risk. The shared stories show that people can be denied medical care because:* they have problems with their financial insurance * the medical institutions may choose to discriminate against people because of their religion, race, age, or some other factor* the quality of care to a medicare patient may be less than to someone with private insurance* some care is banned due to government or religious rules* police are engaged in law and order in which sometimes the ORDER is more important than the LAW or the medical health of the people who got detained﻿

+Alister Macintyre Yeah, and I think you've made your point quite well. Additional support is probably not necessary, but if you'd like to continue offering examples, maybe you could put them all in one comment?﻿

+Earl Hollar My internet connections are flaky. I like to get something in, then save it.Other people on G+ have said they are not fond of edited comments, because in a long thread, they read it, then don't see it got changed.For any one combination of the facts, there are probably many other examples of the same kind of incident. I do not care to here share additional of same kind, rather I am interested1. What kinds of incidents.2. Are there any statistics to show how often this or that kind of thing happens? News media like to share stories which are a surprise, something unexpected. Maybe they are that way, precisely because they are somewhat rare.﻿

I hear that so much. I'm libertarian, but not libertarian. I agree with most of the philosophy.When will humans realize, nobody shares any philosophy. We just have really similar views. It's about as Bayesian as you can get, but people aren't comfortable there.If you are libertarian because you agree with most of it, that's all that matters.When did being part of a party go from, "I mostly agree with these people on key issues, save for a few." to "I'm a drone and completely in line with this party's rhetoric." And who DEFINES that rhetoric of that party?

I mean... It's silly and takes a lot of time. Or just say, you're an independant with libertarian leanings...

We've got lots of forms that we used to encode vast bits of information (here's a general assumption you can make about me, I'm a Republican) that we would then refine in detail up close (I support gun control though, because I don't agree with people in my neighborhood owning automatic weapons).

When did it become so important to distance ourselves so we're not seen as...

Is it that the politicians we support we all agree are bug-frackin nutz? And so, since they're the practical embodiment of our political parties ideals (it used to be just representative, but I feel America is getting really weird these days), we don't want to be identified too closely with the very objectified human we're supporting?

+Earl Hollar It's intriguing that we almost seem to inhabit parallel universes... Your views are definitely consistent, logically argued, and ruthlessly honest. I don't think there's any rational way to argue against your point of view. But still...

Perhaps the difference comes from the end game. In your case, the best endgame is indeed moving to a remote part of Canada. You can't realistically really win against the government, so a smart man picks a fight he can win. In that context, your views make eminent sense.

But for most of us, I think the desired endgame is to stay within current society (some may want radical changes of course). And in that context, a radical libertarian view is highly problematic. I think you alluded to that already -- it works best in communities of a few thousand, but not so well in communities of millions.

So I think that clarifies the difference, for me at least. My end target is quite different from yours -- I have no desire to withdraw. And that means that I can agree with +Alister Macintyre and +Richard Sewill that what you propose would be pretty horrifying and inhumane in our context. Because I do think it is.﻿

+Jera Wolfe Parties became pigeonholes in the US probably sometime in the last century, but I guess if I think about it, humans have always been big lumpers: you're from this nation, you act this way; you're this color, you act this way; you have a membership card to this party, you act this way. Inaccurate and often saddening. I'm an American libertarian atheist, so you can imagine the lumps people often put me in!

+Jakke Mäkelä Oh, I don't desire to withdraw! If I were younger, maybe my endgame would be different: I used to believe the United States could operate on my kind of government, and to some degree I still do, but it'll take too long and I'm too lazy. :) If there were some other nation that'd make me god-king, I'd certainly enjoy giving it a shot. [I investigated locating some terra nullius and settling it with some like-minded persons online several years back, when I was younger, but it turns out there's really no more terra nullius.] I genuinely believe you could do libertarian-ish-ness writ large, but it would require a whole host of other changes, and it would come at a cost you and people like you would find deeply unsettling.

And that's exactly it: it's about the price you pay. The price you pay for security is what I would call tyrannical and draconian; the price I'd pay for liberty is what you'd call horrifying and inhuman. Amusingly, as we stand here looking at each other, there are people beyond each of us: there's a man behind me who thinks all government is coercion, and there should be no law; there's a man behind you who thinks every service should come from the government, and taxation and benefits should be total. We'd be as horrified to live in their desired nations as we would be to live in each other's!

I've tried to find solutions which give maximum liberty to the largest number of people - basically, opting into social programs like pensions and health care - but despite about a zillion conversations about it online, we've never managed to make all the shoes fit. Still, I feel that's the ideal goal [or at least my compromise position]: try to arrange it so everyone get choose what they want their government to be for them. Still working the kinks out of that one.﻿

+Earl Hollar It's an interesting compromise we're reaching here: I accept that you see my world as tyrannical and draconian, you accept that I see yours as horrifying and inhuman. I don't know if there's a term for it -- it's not really mutual respect. Symmetrical disrespect perhaps? :)﻿

+Richard Sewill Libertarians are typically torn, being legislatively conservative but socially liberal. [Republicans want a government so small it'll only fit in your bedroom; Democrats think every problem has a government-shaped solution.] A lot identify as "Independent," [or in their own party, obviously] but then still have the difficult choice of which person who half-agrees with you to vote for, or if you'd like to throw your vote away.

The reason multiple parties didn't get a hold in the US has, I suspect, a lot to do with us not being a parliamentary democracy, but yeah, probably another excellent question for another time. [And thank you for this excellent topic, by the way!]

I think it just means you've finally found some idea of how you differ. So you have a better understanding of the other person, and understanding is a type of relationship, usually ends up in friendship unless there are other factors that separate.Once you can respect how the other person comes to conclusions, even if those conclusions are wrong, you can't help being intellectually honest that you might be the one wrong, and since you can see how he got there, or at least that he's not inimicable to considering your side... then... it's really just... there you are.﻿

I've realized there is one benefit to a smaller government. It's easier to control.Today, Republican party seems to want a smaller government because its easier to control and will let corporations get away with more.

By reducing the role of government in people's life, you also reduce the power it has to protect them from exploitation.

I don't see many benefits in a small government at this time, with this country's direction and ethics.﻿

From my point of view, what +Earl Hollar is doing sounds reckless and insane. You're effectively gambling with your life. In the middle ages, when there was no good health care, people didn't have any options, but nowadays we do. Why would you deny yourself that option?

You say that you prefer if everybody takes responsibility for themselves, but to me that sounds isolationist and cold. Lots of people do take responsibility for others. People marry, have kids, form communities, share burdens. Solidarity can go a long way. I'm assuming you don't have any kids, because if you did, I would consider it criminally negligent to gamble with their life and health the way you gamble with your own.

That said, Netherland also has some tiny fringe religious communities that opt out of inoculation for their kids. Rather a controversial topic, because they too are gambling with their children's health, and worse: they're keeping old diseases from being completely wiped out. Some are coming back.

In any case, a good health insurance system is easily the most effective way to share that burden. A serious hospitalization can easily bankrupt a family or a small community. Not to mention the fact that people incur much higher costs by postponing treatment they can't afford.

Having the freedom to visit a doctor whenever I think I might need it, is a freedom I wouldn't want to go without. Call me spoiled, but I've grown used to civilization.

And that's honestly what this feels like to me: a vital aspect of a civilized society. I realize that a lot of Americans feel differently, and have a much more frontier, do-it-on-your-own mentality. Which I suppose is good when you live on a frontier. But I don't, so why would I?﻿

+Jakke Mäkelä Perhaps most amusingly of all, either of us would probably live just fine in each other's ideal worlds: I lived in northern Europe and absolutely adored it, and I strongly suspect you could live in Hollar's Libertaria and quickly adjust to cauterizing your own wounds and helping out your friends, neighbors, and community. Oh, I'm sure we'd rankle, try to take the bit between our teeth and lead off in another direction, but it's astonishing how little most of this truly matters. We'd probably even get by in anarchist Africa or communist China. As much of a fuss as we make about government, it touches our daily lives less than we usually feel as though it does.﻿

+Martijn Vos, I live in America, and I cannot visit the doctor when I need too. I can now, after my military service, but it doesn't extend to my family.Our hospital costs keep us from moving forward, even doctor bills can whittle away what little we have.I can't imagine having to deal with a real operation or serious illness...That scares me.I'm always in terror of getting sick, as an American. I don't have medical insurance. My wife almost died from the same thing as the woman that +Alister Macintyre posted.

And we had to go to an Emergency Room, we found out she had bloodclots, and was pregnant at the same time... and she almost lost her life, was in the hospital for six days... all because doctor's refused to see us despite having cash for the visit, but no medical insurance.

I would give anything for socialized healthcare right now, and SCREW anyone who would rather my wife die for my lack of funds than help provide a system that can do more to save more people.

People who want to tell me to let my wife just die... can... honestly... Burn in hell.

I don't have time to wait for everyone to figure it out, nor do the sick people, nor do the firefighters that are facing rising hospital bills that dug people out of the WTC site.

Lets be honest, America is one of the more unethical countries in regards to healthcare that actually has a healthcare system and economy that could provide socialized healthcare, and could also benefit from it.

It's not about freedom. Freedom requires being alive and healthy. It's about greed.And money.﻿

And as I pointed out above, I had the money on hand.No, this healthcare system is about getting you into the insurance system, which I just can't afford... save plans that don't actually provide ANY support...

The one offered through my most recent business, was you pay 99 dollars out of each check, and each year, they'll pay up to 1000 dollars on any medical costs you incur (with a host of exceptions that didn't demolish the plan, actually covered a lot).Save it had a 500 dollar co-pay.And realize, you're paying 45.50 26 times a year, but only getting 1,000 dollars back for that.Do the math, I did, and realized even if you got sick, you were still losing 200 dollars!When I pointed this out, the manager said the company required them to offer it and encourage people to pay for 'insurance reasons'.Thus, in telling everyone to get off of it, I ended up getting fired.

+Martijn Vos Lacking insurance is certainly gambling with your life, but it's typically a winning hand. You'll almost certainly never get out of car insurance, or homeowners insurance, or renters insurance, what you put into it: that's the gamble of insurance. But if you lose, well, you typically lose big. You may find the choice I'd make reckless - sometimes, I do, too! - but I feel it should be my choice to make. In the same way that I wouldn't force you to live without insurance, I don't feel it's appropriate for someone to force me to live with insurance.

Personal responsibility might sound cold to you, but that's only because we haven't talked much about the warm side of it. Where I come from, people help each other, because we're part of a community, of friends, family, or just geographical accident. In fact, to us, government assistance is what's isolated and distant: instead of taking Mr Martin a pie when he can't walk to the stove, the taxman takes two bits out of your check for the week and that's all you ever think of it? I don't know how much time you've spent in rural America, but my Dutch friends felt it was...well, the opposite of isolated and cold. :)

Contrary to your presumption, I am indeed a single father. My daughter has superb health care available to her, and is in excellent health, and in the event of a catastrophic illness or accident, she will be well-cared-for. Government or private health insurance isn't the only way to care for your children. Also, I will thank you to leave my child out of the conversation: this has been a very civil and productive discourse, but when people start impugning others' parenting with phrases like, "criminally negligent" and "gamble with their life," it becomes much less so very quickly. In return, I won't detail the million ways your possible children would suffer for your philosophy. Thank you so much.

Self-reliance is definitely a part of our recent frontier heritage, but I don't live on a frontier, either, and yet I want maximal liberty with minimal invasiveness. Why? It's my preference that I and those around me make our own choices, whose results ideally stop right before someone else's start; having choices made for me is anathema to my valuation of liberty, in the same way that living without health insurance is anathema to your valuation of security. Does that mean you're a tyrannical maniac and I'm criminally negligent? No: it simply means we assign different values to different characteristics. Your kind of safety isn't particularly important to me; my kind of individual capability isn't particularly important to you.

The ideal solution would be one by which we both have what we please, and neither of us forces their position on the other; it seems more effort along those lines - rather than in detailing how we differ - would be productive.﻿

+Jera Wolfe That hospitals refuse to treat you is bizarre. As far as I know, hospitals here will always treat you, even if you're mysteriously uninsured. First save the life, then worry about the money.

Don't think our system is perfect, though. 10 years ago we had ridiculously long waiting lists for some treatments. Also, hospitals apparently charge insurance companies more than they should (though this also seems to be the case in the US). And in France, access to medicine is so common and natural that people use way more than they need, which also ends up costing quite a bit. Apparently there's an enormous debt hidden somewhere in their system. So there's no silver bullet. Even with the best system in the world, you still need to keep paying attention.﻿

+Jera Wolfe That's one of the problems with the modern American insurance company: it rests at the intersection of profits and health, an uncomfortable moral position, and due to our legal system's decisions, it must always choose profits. Do away with the expectation of insurance - caused by tax breaks for employers who provide such benefits - and you lower costs, much the same way my price to get a new windshield is very different depending on whether I'm paying out-of-pocket or through AAA.

Of course, the other way is to get rid of profit-driven insurance altogether, which is a completely workable solution, and excellent for people who place a high value on security. That's not to say such systems are without flaws - my Dutch, British, and Canadian friends bellyache as much about healthcare as do my American friends - but it's typically a better solution for those who like to know things are probably going to be okay tomorrow.

Of course, it would help if the US weren't so good at profit-izing everything: we've made health a business, with marketers. "Don't buy the sickness on TV: you want your health, they want the fee. You see the ads and start to think, "I feel it coming on." We're a nation of absurd hypochondriacs. I often miss the Dutch, who break their arm and maybe take an aspirin, as opposed to Americans, who get the sniffles and go to the ER.﻿

+Jera Wolfe Like +Martijn Vos, I can't quite grasp what happened. You had cash for the visit, but were denied treatment? Typically you can't be denied [edit: necessary] treatment, period, and denying treatment on the basis of inability to pay is typically profoundly illegal in the United States, as in the Netherlands. Very strange.﻿

Well, my wife was having trouble walking from inexplicable pain. I'm not one to run to the doctor. You'd be surprised how many poor people are hypochondriacs and actually visit the doctor as much as they would like.It costs!But to them, health insurance is as necessary as a car.But those are the choices I have to make right now. Do I buy health insurance for my family in case they get sick, or do I pay rent.

Those are my choices. It's great to HAVE choices, but they have to be there, and be practical.

Most people don't get any choice, their option is none, if there is no service available in the health arena.﻿

+Earl Hollar I didn't mean to criticize you as a father, I just wanted to explain how such a situation looks from my point of view, which clearly is very different from yours. I believe very strongly in the rights of children to the best possible health care, education, etc. Even to the point where it reduces their parents' freedom, which it inevitably does. Having a child is an enormous responsibility. I have a son, and I feel like I live at least as much for him as I live for myself. But I do it gladly.

Our opinions are not entirely at odds, though. I too believe strongly in communities, and in their reasonable autonomy. I would like to take a lot of sovereignty away from the national level and give it to local levels, bring it closer to the people it involves.

But health care is one of those things where you do need some scale to do it right. The costs of a serious illness are too much for a single family to bear, and even if spread over a small community, the costs can be crippling. A small epidemic could devastate such a community. The wider you spread those costs, the easier it gets for everybody.

And while I've got excellent contact with my neighbours, I wouldn't want to expect them to pay for my medical bills. To me that would feel like I'm not taking responsibility for myself. I have the option to pay for health insurance. Suppose I had the option to choose not to do so, would it really be more responsible for me to save a few bucks every months and then expect others to bail me out when I do have serious medical costs? Should I ask my church for money that could have gone to more deserving causes?

Of course this is also a matter of group-think. If my community all has insurance, and I don't, then if I ask them to chip in, I're asking them to pay twice, just because I messed up. If in my community nobody has insurance while I do, they will probably expect me to chip in and thereby pay double, and I might risk placing myself outside the community. So whichever situation we find ourselves in, we're effectively forced to conform to the community. Not really a lot of freedom either way, in that respect.

I too want maximum liberty with minimal invasiveness, but I feel something like good, simple health care insurance is vital for that. It's not something I want to have to worry about; I want to put my energy into the things I choose.﻿

My father died of blood clots, about 40 years ago. Medical science was not as good then as it is today. He had needed medical treatment for a minor ailment, which caused him to be laid up for a short time. Blood clots developed in his legs. He was scheduled for surgery, but the blood clots did the damage first. I don't remember if they got into his heart or his brain, but it took him fast.﻿

Statisticshttp://www.usatoday.com/news/health/healthcare/health/healthcare/story/2011/06/Study-shows-Medicaid-kids-are-denied-medical-care---/48488756/1I do not understand this. I was on employer insurance for decades, then employer dropped it, and I could not get private insurance (overweight and addicted to caffeine), but I would still go to doctors offices, tell them I would pay in full, they treated me. Then I went on Medicare (my age is now 68), which operates very much like the employer insurance did. There's co-pay ... I pay $20.00 or whatever for the visit, then bill goes to insurance, then it comes back that they pay like $5.00 for this or that, with the remainder going against the annual deductible which goes up each year, then I pay the remaining $80.00 or whatever of the bill.The medical people get paid in full, whether it is by Medicare, Medicaid, employer insurance, private insurance, or out-of-pocket. The only difference is the speed of being paid, and the BS they have to go thru to file the claims with the insurance company.﻿

I pay about $250 a month to get that Medicare coverage. I also paid a lot each year I was employed (almost 50 years.) I have the coverage because I look upon it primarily as a safety net in case something major happens. Medicare would be solvent if it was not for the politicians treating the accumulated funds as an ATM.There has not been a single year for the past 40 years when I incurred as much as $150.00 in medical bills, except when I had major dental work, and needed replacement eye glasses, which were not covered by the insurance anyway. I now expect that in the next few years I may need a hearing aid.﻿

In the so called old days it was survival for the fittest but only because medical was limited to what your doctor knew. It was the rich that said survival for the fittest. They proved this on the titanic by denying people the right to live because they were on the lower decks. They refused the poor to leave the lower decks, kept the doors locked.

Doctors of the 17 and 1800's treated by accepting what ever the family could spare. A chicken, some eggs, some veggies. But the only place this was not the case is where the rich and the powerful were abundant in the big cities.

Today we have advances in the medical field that the 17 and 1800's never dreamed of.

Today if you were to walk down the street and see someone get hit by a car and not call help to them would you be charged? Neglect? Yes. Maybe you would not render them aid because you would not know what to do in their case, but if you walked by them, along with several other people, and it was caught on camera you probably would become famous on the news for having a "I don't care attitude. It would be all over the web too. Just like the China case of the little girl hit several times, and everyone walked on by.

So today we have many saying that we have reverted back to survival of the fittest. Can't pay? Too bad. Ha ha. But your forgetting one thing. Your money can be here today, and gone tomorrow. You might be the rich punk on the street hit by a car in down town New York. But you don't have ID on you, no proof of insurance, and you can't tell them crap. so... too bad.

Barbaric don't you think? Have we really become a Nation of "I don't cares?" Or is this more about a population out of control?

Or is this a Nation of people for the people? I can't tell. All I do know is that people are dying over simple, treatable, diseases.

People would rather fight over who has a right to health care, than do the right human dignified thing. We are not barbaric. The rich have educations, good jobs, and money. As far as I know they did not lose their compassion in the process of getting educated. Money does not make you a god either.

We are all human - above the animals. To treat another human like what an animal would do is worse than any animal on earth. We don't deserve to be called the higher species. We shouldn't even have to have this question, or conversation. How pathetic is that?﻿

+Martijn Vos Well, that's exactly it, isn't it: we'd each like to have our own choices on what to worry about. The problem with government-mandated insurance is that it forces me to take a particular action. Now, you don't find it onerous, because you agree with what you're being forced to do, but that's the inherent unfairness of government-mandated anything.

So wouldn't a superior solution be that you're free to join together with like-minded persons who also don't want to worry about their own health - which seems odd to me, but not personally offensive - in a collective of sorts, in which you spread the risk out among the various members, with some members taking an extra portion of the resources in exchange for managing the whole thing. And in the meantime, I'm free to go about my business, being neither a burden to your collective nor forced to be a member of it. You get your group distribution of risk, and I get my freedom: we both get to worry about what we choose. Is that not an acceptable solution?﻿

Everything +Cindie Gilbert just said.Like the Firefighters who are being denied coverage for their illnesses that may, MAY, be linked to the work they did at the WTC site...

They're our Heroes, do we care if its a cold or a broken leg in the line of duty, if they're spending their work risking their lives to save those of us who are, if they weren't there, already probably dead?

What ethic does the nation want to maintain?Why do I see Canada as a better country after having served during wartime for this country?Because, while we espouse a great ethic here, we don't live it at all, we don't even really talk about it when we talk policy.We talk a very different ethic when it comes to practice. Because it might cost.I keep hearing that the most economic booming times were during times when the rich had some of the highest taxes. They still lived in luxury compared to their fellow man. But they also poured a lot of their funds back into the men around them, through taxation and investment...

Today, the only people who are expected to sacrifice for the 'greater good' are those with increasingly less to sacrifice.

As one who's already paid some of those sacrifices, and lives in pain the rest of my life, I am saying, 'Enough's enough."

+Cindie Gilbert I agree completely... there are doctors who won't treat someone without payment... but I'd bet there are a LOT more who will help anyone that needs it. I think the the system itself is broken...

I've felt for some time we need to pop up a LOT more medical schools, offer full scholarships for medical training, and FLOOD the market with doctors.

I also feel at the same time that we should make medical gear less expensive by being dead serious that all medical patents expire exactly 14 years after the patent is filed, whether it gets modified or amended or not. and that all trial periods for medical treatment is part of that patent period.

Open competition for medical equipment on a vast scale. flood the market... why the hell does a sonogram cost 200,000 dollars, when it's an oscilloscope attached to a modified microphone and a computer? They can make this stuff a lot cheaper... but why would they, when the hospitals are happy to pay the 200,000 dollars for them?

Dean Kamen built an automatic medical dispenser that the medical profession did not want... it's now a pop machine in upscale burger places.

I also think that patients should always be given an itemized list of all expenses, that they can discuss directly with the hospital, hand to their insurance company, and share with anyone that wants to help them contest the expenses.

The crisis we are facing is due to the COSTS... and the costs are artificially high.

How come veterenarians, using exactly the same equipment (mostly) don't charge the same amounts?

People should not have to pay with their life savings to continue to live.

+Laston Kirkland Delay the clock running on those 14 years until after the government lets the inventors start putting the product on the market. We need FDC USDA CDC whatever approval of new stuff into our bodies, but sometimes the approval process takes eons.﻿

fine... the clock starts running as soon as they sell one, or rent it out, or other wise make money off of it. but there is a clock and the expiration means ANYONE, ANYWHERE can make it and sell it. whether its a drug, a prosthetic, or a medical machine

when the technology matures I FULLY intend to 3d print a davinci style surgical robot, and GIVE the damn things away at cost.﻿

+F Lengyel There is a third axiom: 3. Resources must be infinite.When they're not, priorities must be made as to who is treated and who is not with the finite resources.

So in reality there is an implicit cap. In universal coverage, that gap is fuzzy or not numerically defined. Should it be?

A Question for +Think Tank: Should decisions on how to prioritize public health care be based on explicit rules and objective numbers, or should the decisions always be made on an ethical case-by-case basis?. [This may be functionally identical to some of the other questions posed, so it can be ignored].﻿

I've always turned to medial ethics on who gets treated with what resources. This is not an economics issue that could be better treated by an economist.

What is at risk of being lost here, is the privilege that having money can bring for better care. Say your child is at risk of dying, and has a very low chance of survival. But if you have a lot of money, and its privatized health-care, you can afford to get care instead of people who cannot afford it, with much higher chances of survival...

This whole argument only benefits people who can afford healthcare, as if its a privilege money can buy.

If it is, a privilege, then let me be frank... I'll accept that, and just move to Canada. I believe it should be something we afford all citizens.

Because its ethical, and it benefits the society in the long and short run. But it means that sometimes, regardless of how much money you have, you may not get in front of people who actually can be helped with the limited resources...

+F Lengyel OK I agree, it only follows if a very strict (maybe nonsensical) definition of "universal" is used. I take it to mean that everyone who can be treated is treated (even if the expected benefit for everyone is minuscule). Which is not possible with limited resources.﻿

See, this is another example of apples and oranges, I think. You don't spread out medical care like that.Some people need very little, some will need more, but all will need some and it can be expected to be more or less at certain points in people's lives.

Individuals in hazardous jobs can expect to need more medical care than those who do not have hazardous jobs.

As age increases, medical support and needs will also increase.

Some conditions will be treatable, others will not, but quality of life still should be ensured (people should be given things to help with chronic conditions, pain killer, so forth)

You don't spread it out and divide it up, like a tax burden.Medical needs follow biological patterns, not artificial systems of supply and demand.﻿

+Richard Sewill There should not be caps on anything that is just like taking medical coverage away from someone.

I raised a handicapped child in his first year of life his medical bill was over $225,000 just for the hospital. I stopped counting the amount because the bills were never ending. I am sure it was well over a million and maybe even two million by the time he reached his third birthday. Oh and he was born in 1977. Can you imagine what his bill would of been today?

Finding Doctors for him was bad enough, but having to find insurance too because of the cap? Can you imagine the people not being able to find insurance, and having to find a Doctor that will accept the insurance. Then having to deal with cap after cap?

That is what will happen. The ones that need 24/7 care will have roadblock after roadblock eventually running out of insurance, and Doctors. I have not seen a bill passed this year that did not have a means for someone to skirt around the Bill that was passed.

Caps are a bad idea.

Sorry about the previous highjack. I did not mean too, but it is still related in a way. Next time I will sit on my hands, and bite my lip.﻿

+Earl Hollar What action do you feel you're forced to take? Pay some money? That's no different from taxes, paying for food, paying for shelter, etc. Living costs money. In fact, universal health care could be paid entirely out of taxes. I dare say it's money much better spent than the vast majority of what governments spend their money on. And most of the other things that governments spend their money on, restrict your freedom far more.

Personally I feel that good universal health care gives people freedom. If everybody has good health insurance, people can go to the doctor, ER or hospital immediately whenever they need to, without first having to check whether they're insured or can afford treatment.

Imagine a situation where half of the people have insurance and the other half doesn't. You'd be faced with the situation that half your community might not be willing to help out, since they're already doing that by paying for insurance and you chose not to make use of that. Meanwhile it's likely that mostly sickly and disabled people will use insurance, while people who are healthy tend to choose to go without, driving up the costs per insured person, because there's a smaller pool to share that burden. And what if someone without insurance suddenly faces enormous medical costs. Can he suddenly get insurance and enjoy the full benefits of it without having paid for it during his healthy years? That'd hardly be fair, would it? So insurances will likely be able to refuse people, and you end up with cheap insurance for people who are never ill, and hideously expensive insurance for very sick and disabled people. The entire principle of sharing the burden goes out the window.

So what real, substantial freedom is there to be had by going without insurance?

By comparison, imagine a society where you have the option not to pay for the fire department, the police, or for sewers. The fire department would first have to check whether the house on fire is actually paying, and then they'd still have to move out and save all the surrounding houses, while the burning house is still a threat to the neighbourhood. It drives costs up for everyone, without providing any meaningful freedom. Having the freedom not to pay for police might give you the freedom to get robbed blind and being unable to do anything about it. Or maybe rich people would hire their own private police that only provides justice to the rich, while the poor police lacks the resources to accomplish anything. And if you have the freedom not to pa for sewers, and just dump your sewage in the street, you're creating the same danger of diseases that plagued the middle ages.

The freedom not to pay for a vital aspect of civilization isn't really a meaningful freedom, as far as I can tell. But if you have an interesting insight that I haven't considered, please share. I would really love to understand what sort of freedom you enjoy in your situation that I lack.﻿

Ah, well I consider spending a tenth of my yearly income on health coverage I don't want to be real and substantial, and I don't find health care a "vital aspect of civilization." [We had civilization for, like, ten thousand years without health coverage; it ain't that vital.] But you can lose other freedoms, as well, depending on the system: the ability to carry lesser insurance, for example, or to choose an insurance plan that is tailored specifically for yourself and your family. Under many plans, you lose the ability to choose which doctor you attend, as well, like an HMO but non-voluntary; this is true of Medicare now in the US. These are also substantial freedoms in my mind.

You think health insurance is better than most things governments spend money on, so you support it, but I don't. So why not give each of us the freedom to choose whether or not we have health care? Again, why not allow me to not carry health coverage if I so choose, while allowing you to carry it if you wish? I wouldn't force you to not be covered, you wouldn't force me to be covered: maximal liberty. Don't think of it as, "Hey, I like this expenditure, so it must be okay," think of it as, "Does this provide a community benefit that cannot be achieved through non-communal means?"

If your house catches fire, mine could catch fire, so it's to the community's benefit if we keep your fire from spreading; the cost of maintaining fire equipment for each of us would be enormous, and we don't have the training we'd need to accomplish it, anyway, so fire protection kind of has to be universal. I should point out, though, that there are areas in which fire protection is not universal, and in which if you haven't paid, you don't get the service. Yes, this does lead to some of the problems you've described; there's often some personal price to be paid for liberty, but the point is that the individual should be free to choose, irrespective of what you think of the price. Can someone wait until their house is on fire and then pay for the coverage? No. Will their house thus burn down? Quite possibly. That's their choice to make. You might not agree with it, but you don't have to.

The fire metaphor's a good one, too: health coverage can affect the guy next to you! That's why I do support government-mandated and -funded vaccination. But because of the risk of my fire burning your house, I not only have to carry "fire insurance," but I also have to maintain certain standards: short grass, an inspected electrical system, certain types of materials, because if I don't maintain this certain standard, your risk goes way up along with mine. Logically, we should be able to do this with health care, as well: if you eat nothing but Pink Cookie and crushed cigarettes, you're going to massively increase the cost of my health insurance, since we're bound together in this, so logically I ought to get to tell you what you're allowed to eat, as well, and how often you should exercise.

I'm not much of one for slippery slope arguments, but it logically follows that you should be able to control anything that influences my health, and that's also not acceptable to me; it's not acceptable that someone else would control my behaviors to this level, and it's not acceptable to have universal health coverage without such control: my neighbors eat like shit, and right now that has minimal influence over me; my health care costs are influenced primarily by my behaviors. Dump me in a risk pool with all of America - a third of us are obese, you know, and another third overweight - and my health care costs are influence primarily by other people. That's not individual liberty, that's placing the collective ahead of the individual, and while I understand you don't mind that, I most certainly do.

So, again, why not let you do as you please, and let me do as I please? You're free to carry health coverage, I'm free to not carry health coverage; maximal liberty. Why are you going to force me to carry health coverage? What right do you have to make me carry insurance, when my burning house doesn't set yours aflame? If I get cancer, the worst that happens to you is some indirect economic effect; that's very different from embers flying off my house and setting yours ablaze.﻿

It's probably worth pointing out that I don't support forcing auto manufacturers to put airbags in their cars, either; my valuation of liberty is extremely high in comparison to my valuation of safety. Of course, my car doesn't have a roof, or doors, or an airbag. My life is really not very much like many other people's, which is fine, so long as we're all given the freedom to live the lives we choose.﻿

The lost freedoms and restrictions you mention are not intrinsic to mandatory health insurance. I am required to have basic health care, which is mainly doctor's visits (first line care and diagnosis that needs to be as accessible as possible) and hospital stays (the stuff that bankrupts people). On top of that, I'm free to choose dental, physical therapy, and tons of other stuff if I want, or leave it if I don't want it. I'm free to choose my own doctor, dentist and hospital. Mandatory health insurance can go very well with freedom of choice in areas that matter. Things like a discount for having a healthy lifestyle are not impossible either.

I'm detecting a deeper disagreement between us, though. Should someone who is afflicted with bad health or disability through no fault of their own, have to pay much more than someone who's lucky enough to be born with the healthiest genes in the world? I'd like to give everybody equal chances in the world whenever possible, so I favour solidarity in this case. The opposite position would probably be that life just isn't fair, so don't try too hard to make it so.

So what's the real downside? Mainly that it's going to tempt people to save a few bucks in the hope they won't get anything serious. And people who change their mind later may have a hard time getting insurance. "You thought you didn't need it, and now you do? There's probably something already wrong with you." That choice is not going to be as free as you'd like it to be.

We could do something like children automatically having insurance, and once you get older, you can choose to refuse insurance on principle. And once you do that, the way back might not be easy. Would that work for you?

+Earl Hollar I don't really see how airbags would infringe on my freedom. My freedom is much more seriously reduced by border checks, customs, phone taps, police overstepping their role, corporate interference in politics, etc, than by paying some (in my opinion minor) amount of money for something that makes society nice.

But I once heard a proposal to replace airbags by a sharp steel spike, in order to encourage motorists to drive more safely.﻿

Here's the thing. we have three separate supositions going (four if you add MY two cents.)

+Earl Hollar feels that being forced to buy insurance is a bad thing. He wants the right to live his life as he sees fit, choosing to take the responsibility of his own life into his own hands. He might buy insurance, he might not. but he wants it to be HIS decision.

+Alister Macintyre wants to expose corruption, stupidity and cruelty inherent in large systems, pointing out how dehumanizing they are. He's otherwise for universal health care

+Martijn Vos and +Jakke Mäkelä are surprised and appalled that people live where health care is not a universal given, and are trying to wrap their mind around opposition to this. Something Earl is gleefully providing.

The wrapper we are putting these positions in is about whether there should be a cap on expenses occurred from health care. but each person has trouble talking about that without clarifying their own positions first.﻿

+Martijn Vos It's wonderful that you support a level playing field, inasmuch as that's possible. I don't, personally, and I'm certainly not saying that because I'm on the high end of the field! But again, if you want to level the playing field, I wouldn't dream of forcing you not to, so why is it okay for you to force me?

Mandatory health coverage costs more than "a few bucks." If I'm required to pay for health insurance, it will have a major, massive impact on my life and that of my family: again, we're talking about more than 10 percent of my yearly income. My income is already lower than my expenses, and while I've a support network established for emergencies, "yet another bill" isn't the sort of emergency my network can aid with, particularly since all of them will have to be paying, too.

Additional cost, at the very minimum, is intrinsic to every mandatory health plan. [The other restrictions of freedom are incredibly common, but not necessarily intrinsic.] So again, why not allow freedom? Why not let you take that expense, if you choose it, while not forcing it on me?

Mandatory coverage for children which they can discard at adulthood is dicey. While I personally agree in principle - I don't even support piercing the ears of children until they're responsible enough to make that choice for themselves - I do have some cautious concern about government deciding what's best for children, about taking rights and responsibilities away from parents and putting them into the hands of the populace. This is a pretty innocuous example of the form, but I would be very, very cautious about the execution of it.

Airbags infringe on your freedom by raising the cost of the vehicle tremendously [design, testing, materials, etc], by reducing your ability to service the vehicle yourself [you really, really don't want to work on a steering wheel with an airbag in it!], by restricting the available designs [my own car would be quite impossible to put passenger airbags in without completely ruining the fundamental dash design], and by adding weight [which reduces efficiency, raises costs, and adds mass which reduces performance in every measurable way], among other things. [Not that I should need a reason: by my standards, it's the "I'd like to take some freedom from you," side that has the burden of proof, but I don't mind explaining myself. :) ]

Now, you don't mind that. That's a great exchange for you. You value safety much more highly than cost, design, self-repair, efficiency and performance. It "makes society nicer," in your view. [Your view considers the several hundred dollar cost of an airbag "minor," which is very, very, very, very different from my view. If you buy a modern European sedan, there's a good chance you'll spend more on airbags than I've spent on my entire car!] Great! Then you should absolutely be free to buy a car with an airbag. But why should I not be allowed choice in the matter? Why should your valuation - significantly different from my own - outweigh mine? If my airbag saved your life, I could certainly see the argument, but that's simply not the case.﻿

+Laston Kirkland By far the wildest and most animated discussion so far, for which I applaud +Earl Hollar (while disagreeing with everything he says). :)

Here's my proposal: +Think Tank the moderator could try to define what the main threads are, and propose separate Questions that will be made later. That way we can continue the discussions later on those threads. You can probably identify six or seven Topics, in addition to the ones that have been explicitly stated.

This thread is better than any episode of Star Trek! It's wild how we can seemingly have people from different planets right here on one planet.﻿

+Earl Hollar I don't want to go into the airbag issue, because I don't really care that much one way or the other. I couldn't repair my car anyway. I admit weight and economy are issues I do care about. I'm glad our car has them, but I'm even more glad that they've never been used.

I understand that an expense of over 10% of your income when you're already short, is something you could do without. For me, my insurance costs less than 5% of my net income (I think) and we live pretty comfortably, so I don't mind the expense. This, however, is not quite the same issue to me. It's also an issue of poverty. It is already the poorest people who tend to lack insurance. If the cost is the main issue and makes them opt out of insurance, then the whole exercise is useless.

I firmly believe that the very lowest income should be enough for food, a house, and basic health care. (And other stuff, like education.) If your argument is: I can't afford health care, then that's primarily a poverty issue, in my opinion.

So how to handle that? Personally I'd be perfectly fine with funding basic health care out of taxes. That would probably mean that more of my income than your income would go to health care, but I'd be perfectly fine with that. We could simply make it free and paperless, even.

To get one of my favourite political ideas out: I favour a much simpler tax and social security system: everybody, working, unemployed or retired, gets the same basic income and pays the same tax percentage. The basic income should be enough for food and housing, and would include basic medical coverage. I realise that's going to be an even harder sell in the US, but it would solve a lot of problems: nobody would have to die due to stupid, fixable causes like hunger or a curable disease, and we'd save tons on unnecessary bureaucratic overhead. In my view, this would give everybody a lot more freedom to live their life the way they really want to. Only the bureaucrats would have to find a real job, I guess.﻿

And my thanks in turn to you and the others, +Jakke Mäkelä, for making being the only guy on this side of the fence a much less unpleasant experience than it typically is! This is one of the best conversations I've had on Google+, and most timely, as I've been doubting what good comes from my participation here. [Usually it's just me being yelled at for being a religious apologist, or an atheist, or too poor, or too rich.]

+Martijn Vos And here we come again to the reasons for our differences [beyond the cultural ones, of course]: profoundly different life experiences. You can't repair your own car, and live pretty comfortably: I haven't taken any car of mine to a mechanic in a decade or more, and don't own a bed,* television, dishwasher, or microwave. Our lives differ profoundly! That's one reason I strongly favor individual choices, because individuals have very different needs and wants.

There's another point hidden here, as well: like the car metaphor, in which you can't fix your own car so it doesn't bother you when the government mandates something that's not user-fixable, not having health coverage makes me more self-reliant, and much more careful about my health.** My experience is that in Nederland, this isn't much of an issue - "Broke your leg? Take a vitamin and go for a walk." - but here in the US, it's a major, major one. Most people here don't change their own oil, because they can afford to pay someone to do it for them, so when something worse breaks, they're completely at the mercy of the mechanic. Most people here are completely incapable of even basic medical treatment on their own - seriously, I do know people who take their kids to the ER for sniffles - and show a profound lack of ability to manage their own health. [Two thirds of our population is overweight or obese!] So while perhaps it's not a big issue in Nederland - although I though a fair number of the people I met were ponces by my admittedly bizarre standards ;) - it's a crippling one here, sadly.

In many cases, I agree health coverage is a poverty issue. It's not in mine - I used to make twice what I do now, and still didn't carry health insurance - but in many cases, it is. But I view poverty as an issue of personal responsibility, too: if I'd like to be not-poor, there are mechanisms to do that of which I'm not availing myself. Very few people, in my experience, are as poor as they are for purely external reasons: poverty - please, no one throw shoes - is also very often a choice. And I say that standing at the bottom of a very deep hole, not as someone holding the shovel that buries me.

Again, you come from a culture of plenty, with a very high population density; I come from a personal history of scarcity, and live where there are as few people as possible. So we have different needs and wants. How to reconcile them? I genuinely do think there's a place for allowing you to be covered, and allowing me to be not-covered: your primary objection to that is what we do if I get hurt, then. My answer has always been, "Uh, don't treat me," but I understand that's a difficult row to hoe for many people.

What about an alternative, then: if a patient comes in, we treat them, even if they don't have insurance [or if they're unconscious and can't show it!]. Then, we bill them. If they don't pay, the process goes on the way it would if I didn't pay any other bill: collections, eventually civil action and docking of pay, etc. Does this address the primary objections? Individuals are free to choose whether or not they're covered by insurance. In the event of catastrophic injury or illness, the individual who isn't covered still has to pay, but doesn't get denied treatment. What objections would you have to a system like this?

*Yes, before we go down that road, my daughter does own a very nice bed, because she chooses to have one. She chooses to have a microwave, too, but a brother's got to draw the line somewhere. ;) She's welcome to waste her own money on useless objects like that.

**I'm a little weirded out, frankly, by people who can't take care of themselves, who can't fix their own cars, who can't repair their computers, who can't bind their own wounds. It seems like terrifying weakness, to me, so be so reliant on other people for the very most basic needs. We grow much of our own food, do all of our own home, auto, and computer repair, and, yeah, our own first aid. I haven't had to give myself stitches yet, or set a broken bone, but we've everything we need if it comes to that. Okay, if I broke a bone, I'd probably pay someone else to fix it, but it's important to me to be able to do it, regardless.﻿

Ah, damn it: missed one thing. Your favorite political idea, +Martijn Vos, sounds delightful to me, like a simplification of the socialist ideal, a compromise between communism and socialism, with a lot of the overhead paperwork taken out. [Sounds inspirationally like early Culture, too, if those are books you've read!] I genuinely believe many nations will move to systems like that, and possibly even derive enough financial benefit from the investment to cover the people who decide to just laze out and take the dole. [The US welfare state was...troubling. The situation in Nederland is much better, but we both know that's still a major issue!]

Would I live there? No. That'd be a nation of people I'd find hopelessly weak and incompetent and unmotivated. I'd love to visit, and I'd fully support the idea, and I believe it would, overall, make most of the people who live there satisfied. But I'd find it as intolerable as I find my current nation's condition. It's delightful, but it's not for me.﻿

+Earl Hollar who said you were the only guy on that side? I grew up on military bases, and small towns in eastern washington. I know your point of view well. you were eloquent and informed, and I didn't want to steal your thunder.﻿

Iain Banks is still on my to-read list, I'm afraid. But yes, I want to make life simpler and more free. And I do admire your self-reliance. It would be good if more people had that. It's just that I don't care much about cars (I got my driver's license a year ago, when I was 37), and I'm not terribly good with my hands. I can build and repair my own computer (from parts, not from scratch), but I think it's pretty obvious that the majority of people won't be able or interested to do that.

As for my nation being hopelessly weak, incompetent and unmotivated, you might actually be onto something there. It's a complete mystery to me why I'm doing so well in life. I'm terribly lazy, don't feel like I could possibly be responsible enough to take care of myself (yet many of my friends seem to be struggling with that even more), let alone to take care of a kid. I'm just lucky to have been born into the situation I'm in, with a good brain and good health, and somehow everything seems to work out for me. I sure didn't do anything to deserve any of that.

And that's why I disagree that poverty is a choice. Lots of people work really hard, and just can't get out of poverty. Others don't work at all and are filthy rich. Things like choice and hard work definitely have some impact on wealth, but luck has a far greater impact. And that's why I think the lucky/rich ones have a responsibility to share their wealth with those less well off.

And with the misfortune of being poor, combined with the misfortune of having a medical problem, having the potential to destroy your life, well, that just won't do. We can't fix everything, but we can fix that.

Back to the self-reliance: I think it might be very good for me to be dumped somewhere in the wilderness in learn to really take care of myself. I'd certainly love that kind of challenge. But I can't, because I have too many responsibilities, and maybe also because I'm a coward.That said, I live in a society where I don't need that self-reliance. I hire someone to clean my house, I pay someone to fix the car (or actually my wife takes care of everything concerning the car; she knows much more about it), I wouldn't know how to grow my own food (but I admire people who do that; it sounds like a great way to live), and I'd never remodel my own house. But the only thing that's really a disadvantage to me in this society is that I hate and suck at bureaucratic paperwork. Like taxes.

I live in a pretty efficient society where you can get by with specializing in only a single thing, and paying others for everything else (except paperwork).

Oh, and I don't run to the doctor with every little thing, and I've never been in an ER. I have read that an increasing number of people here are pestering ERs with minor problems. I forgot why exactly. To me, ERs are for when there's lots of blood squirting out of you and it won't stop.

Mind you, my in-laws are farmers. They're as self-reliant as you can get. If civilization collapses, we just move to the farm. Yet another bit of luck I didn't deserve.﻿

+F Lengyel Driving isn't made more dangerous without airbags, it's made less dangerous with them. A tiny, but salient, point.

Of course, no one here is saying liberty trumps safety - although some people have different relative valuations of each - so it's entirely possible you're not actually speaking of any of us, anyway. :) That differing relative valuation allows someone to calculate the costs and the benefits, and still decide [airbags/health insurance/expressways] aren't worth the price one pays for them. My car would be significantly safer if it had a roof and doors, but that benefit isn't worth the various types of cost for me [financial, ecological, emotional, social]. Someone who assigns different relative values to those characteristics would likely come to a different conclusion, and go buy, you know, a car. :) But that doesn't mean that the guy with the roofless car has committed an error of calculation, only that the values with which he's calculating are different.﻿

+F Lengyel I got in before the edit, so let me then ask: is the total economic cost of airbags, you think, less than the total economic cost of the injuries they prevent? That doesn't seem impossible to me, but it's also not something I've any evidence to support. It doesn't change my position - the collective isn't my concern; the individual is - but I'm curious about every damned thing. :)﻿

+Martijn Vos Of course you've never been to an ER. :) I'm not even sure why they have them in your country: they must be the quietest places on Earth. You've safe roads and drivers, hideously low rates of violent crime, and a nation of anti-hypochondriacs. I love your country. Couldn't live there, but damn do I love it.

It's interesting to consider the relative influence of work and luck on wealth. There really is an enormous gulf, particularly in my country, between the chances wealthy and poor children have. To some degree, I see that as fine and ordinary, lamentable but natural: if you're born in Uganda, your odds of being rich aren't great, in the same way that if you're born in a burning building, your chances of not getting burned aren't great. While I think choices can have a profound effect on your eventual financial fate, circumstances beyond your control [typically before birth] probably really do play a greater role.

Solutions? Well, I go to the individual, of course: charity. It might seem like madness, given the gulf between us - you pay someone to clean your house! :) - but I regularly do charity work for those less fortunate than I. Your solution [not that you're opposed to charity, just that you'd obviate the need for it] is collective, that we try to level the field before charity is necessary, and I think that's another excellent solution, although again I worry about effectively enabling weakness, and that way lies Harrison Bergeron, and all that sort of thing. But you've definitely given me something to think about in terms of what responsibility the collective has for ensuring individual opportunity. Interesting.﻿

+Earl Hollar Then we both learned something to think about. This really is a great discussion. Probably the best so far in the history of +Think Tank. Thanks for your excellent contributions to it.

One final comment on charity. While I do think it's wonderful and vital, it's also unreliable. It's very erratic. You have to get noticed. Fatigue can set in. It's great for unusual and exceptional cases, but when it gets to common, I'd rather fix the system. Systems are by no means perfect, but they do tend to be a bit more reliable.

And while I have never been in an ER, a good friend of mine has. He was deep frying food in a pan of boiling oil on the stove. It fell over burned his leg. That's stuff to go to an ER with.﻿